CareFirst Boasts $136M in Savings on PCMH

The Maryland health plan, 3,600 primary care providers-strong, says it has saved $136 million in projected healthcare costs over two years through its large-scale network of patient-centered medical homes.

CareFirst BlueCross Blue Shield, the giant Maryland insurer, says it has saved $136 million in projected healthcare costs over two years through its large-scale network of patient-centered medical homes.

More than one million members are served by the 3,600 primary care physicians and nurse practioners who have joined team-based panels to reduce healthcare costs and improve the quality of patient care. There are 297 PCP panels across Maryland, Virginia, and Washington, DC.

PCPs drive the program because they are in the position to best understand patient needs, explains Mike Sullivan, director of external/internal communications at CareFirst. He notes that the PCP is responsible for two of the most "value-laden decisions in healthcare:"

1. When to refer a patient for additional care, and

2. Where to refer a patient for additional care

Most of the CareFirst members in the program are chronically ill with diseases such as diabetes. PCPs develop care plans for these patients with the goal of keeping them from getting sicker and incurring additional healthcare costs.

For their efforts, physicians are guaranteed a 12% boost on top of CareFirst's existing fee schedule. If the insurer normally pays $100, PCMH doctors receive $112. And that is for just participating in the program.